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Dr. Wilber Su,Cavanaugh Heart Center, Phoenix, AZ

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Ira David Levin, heart patient, Rome, Italy

"Within the pages of Beat Your A-Fib, Dr. Steve Ryan, PhD, provides a comprehensive guide for persons seeking to find a cure for their Atrial Fibrillation."

Walter Kerwin, MD, Cedars-Sinai Medical Center, Los Angeles, CA

A-Fib Patient Story #22

Ablation at New Delhi, India for $5,200

Barry GordonMacau, China

By Barry Gordon, 2007

Barry Gordon had his ablation procedure at Escorts Hospital in New Delhi, India. The costs of the procedure including airport pickup, private accommodation, food, etc. were around $5,200 US. The address, phone number, etc. of Escorts Hospital are included at the end of his story.

I am writing this as a closure to the last 12 months of pure Hell. I just returned from India a few hours ago after a roller coaster ride of thoughts and emotions that these occasions naturally bring on, not helped in any way by some unbelievable downers.

MY A-FIB

If you take a bucket of water and pour it down a sink, that’s how a normal heart operates. If you take a five-gallon water dispenser bottle, hold it upside down, and pour it into the sink, the water flows unevenly, gurgles, bubbles up, etc. That’s what an A-Fib attack is like to me. The higher the fibrillation rate, the worse it feels.

The term Ejection Fraction (EF) refers to the efficiency of the heart. It basically refers to the percentage amount of blood in the Left Ventricle that is pumped out at every beat. Normal Ejection Fractions are between 55% and 75%. Anything above or below these figures indicates a problem. Hearts tend to deteriorate with age, leading to lower EFs. Doctors become concerned when EFs get around 30%.

My EF was 67% at 55 BPM normal rhythm, and 60% at an average 110 BPM in the early stages of an A-Fib attack. That’s probably why I usually didn’t feel an A-Fib attack when it started. My EF then would get worse depending on the severity of the A-Fib attack. Any attempt to walk brought on instant dizziness. Eventually I’d get dizzy and lightheaded even when sitting down. The only good thing is that, when the A-Fib attack stopped, the effect was always dramatic. Within minutes I’d be back to normal, especially with clarity of thought.

I have now reluctantly accepted that my A-Fib is probably due to a genetic fault, and that an A-Fib ablation procedure is the final answer. Fortunately medical science today is moving rapidly to stem the flood of A-Fib cases that for some reason is hitting the baby boomer generation.

FROM MACAU TO ESCORTS HOSPITAL IN NEW DELHI, INDIA

After leaving Macau where I live, I arrived at Escorts hospital in New Delhi, India around 11.30 pm on June 11, 2007. Within one hour I was in A-Fib. This didn’t surprise me. My A-Fib attacks had become so frequent that I was getting them every 12 hours. They lasted between 36 to 48 hrs. I was rapidly approaching permanent Atrial Fibrillation.

My heart rate bounced between 110 BPM to 150 BPM with spikes up to 178 BPM. (My resting heart rate is relatively low at between 52 – 58 BPM, probably due to years of exercising.) A-Fib heart rates this high are relatively uncommon. There are heart drugs (rate control drugs) that can be used to lower the general heart rate, thereby minimizing the damage to the heart in general.

I managed to get to sleep that night. When I awoke I was still in A-Fib. But I almost welcomed the A-Fib. The doctors would actually be able to witness my A-Fib as it happened, and could map out the errant signals with all the new technology. They could ablate the actual sources of the errant signs which greatly helps chances of success.

I went through the day being processed and prepped. (By now needles and tests no longer bothered me.) By far the worst test was the camera pushed down your throat so they can check for blood clots in the heart. The worry here was that I may have a clot in the heart due to the A-Fib. This would cancel all further tests, and the whole ablation procedure would be called off. I had heard this two minute test was pretty bad. Many people have to be put under as their throat naturally rejects the tube. I couldn’t help retching and gagging as that tube was forced down my throat. But, determined not to make one sound whatever happened, I got it down at the second attempt.

Escorts hospital in India is good at resolving plumbing problems of the heart. It has virtually a moving conveyer belt of major heart cases being resolved every day, with very importantly a very low incidence of infection, which I hear is prevalent in the NHS. However, no one knows much about the electrical side of the heart, and why people like me who are otherwise perfectly healthy get A-Fib. This is called Lone A-Fib with no known cause. Most cases of A-Fib happen due to other faults in the heart such as Coronary Heart Disease.

The easiest way to stop the errant signals that cause all the A-Fib problems is to have that part of the two Pulmonary Veins that enter the left side of the heart ablated – destroyed – around the joint where the veins are glued to the heart. This is done by entering the heart and causing a series of burns all around the joint. These many burns are like circular spot welds, like constructing a Fire Wall. Think of trying to stop a stream with round stones. Chances of success on the first try are around 50% -70% tops.

THE ABLATION PROCEDURE

My doctors at Escorts Hospital were Drs. Anil Saxena and T. S. Kler. They said they might perform my ablation procedure this very afternoon rather than the next day as I was originally scheduled. So, re-adjusting myself and knowing they would catch the A-Fib attack in full flow, I waited in what was now becoming a bit of a dull headache blur. My heart rate was around 110 BPM. But no one came for me.

There was nothing to do but wait for the next day as originally planned. Expecting to be in the lab very soon, I actually welcomed another day in A-Fib. I was even more eager to get the ablation over with. But at 12.40 pm while I was staring at the TV, my ears suddenly ‘popped’ and instantly my thoughts were clear again. I got that indescribable feeling you get when coming out of A-Fib back to the land of the living. This feeling of euphoria was soon lost as, along with the feeling of relief at being out of A-Fib, I also lost a bit of the cast iron resolve I had saved up. But fortunately I still had some in reserve. At 12.50 pm, just ten minutes after the ear ‘popping’ which had never happened before in my approximately 50 previous A-Fib episodes, in came the nurse and said, “Let’s go, Mr. Gordon.”

Being wheeled into the catheter lab was like entering a spaceship. About six doctors or technicians were looking out from behind a wall-to-wall, floor-to-ceiling sheet of glass in what I presumed was the command center, a similar set up to the ‘Electric Chair.’

I had only one fear. I hate needles, etc. The thought of them cutting a slit in my groin and then pushing in ‘sheaths’ to get the catheters into the body and then manually on up into the heart itself was very scary. Just the nurse cleaning the area had me turning into an iron bar. Still not a sound sneaked out. After they inserted the catheters (think cables in push bike breaks), my main fear was now over; and, feeling OK, I started to relax. I had no fear whatsoever about the welding torch going into my heart. So for me, the worst was over with, thank God.

All this feeling good about myself was brought crashing down as they proceeded to cut into a vein in my throat to push in yet another ‘sheath.’ I became an iron bar again, quiet as a mouse. I was after all an Englishman abroad, and it wouldn’t do to let the good people of the colonies see any sign of weakness in a former soldier of the Queen.

I was by now covered head to foot in heavy ‘lead blankets’ to fend off the radiation, but I could clearly hear my regular heart beat on a nearby monitor. That sound, and the feeling of someone pushing in the cables were my only sensations, easily tolerated.

The catheters enter the heart via the right Atrium, which is where Atrial Flutter skulks in the shadows. Having both Atrial Flutter and Atrial Fibrillation I had discussed zapping the Flutter as well while inside the right side of the heart. The doctor had already decided that was going to happen after reading the many ECG printouts I had brought along with me.

So, now for the welding bit. I could hear someone saying “this point,” after which I got a small burning feeling in my chest. Not a sound out of my lips. I was going to get through this without even a squeak. I settled down for the expected next six hours on the block. The ablation burning went on for about thirty minutes with the “this point” followed by a burning sensation every few minutes, as the guy at my right side manually maneuvered the catheter via the brake cable.

Drifting off to sleep I suddenly heard, “Ok, Mr. Gordon. We are going to enter the left side of the heart now.” “So the Flutter’s gone.” I said, thankful the Flutter ablation was done. A-Flutter sometimes triggers its big brother A-Fib but is easily cured 100%. “No, we will get that on our way out.” This clearly threw me. What were the burning sensations for the last 30 minutes?

To get to the left side of the heart where most A-Fib originates, there is no alternative but to puncture the dividing heart wall (the Septum) (for a further explanation of this part of the ablation procedure. This is what makes the procedure a bit risky. Also they now have to maneuver the catheter cables through a wall of muscle which is a far more tricky situation.”

We are through now, and we will start on the ablation process.” Expecting the preceding burning sensations, I wasn’t bothered and decided to sleep through it all. This was a big mistake. The first burn give me what a mega heart burn must feel like (no pun intended). This immediately made me turn from a ton of lead into a flying carpet. But not one murmur. However, the sound and sight of my clenched teeth cracking and shattering made the doctors decide to bring on the Panadol.

AFTER THE ABLATION

I finally woke up at about midnight in the recovery room with my back absolutely killing me, but it was more of an ache than a pain.

Fast forward about nine hours. Waking from a deep sleep I noticed the beating of my heart. It was a bit fast but in perfect NSR! I got myself out of bed and checked the heart rate on my athletes H/R monitor. It showed a perfect heart beat of 76 BPM, not even a missed beat every now and again. Around 30 minutes later the nurse came in with my first meal in the last 24 hrs. I wolfed the lot down (which wasn’t a lot), then sat on the sofa to watch TV, although I was really listening to my heart beat. “Could this really be true? I’ve beat it and got my life back!”

Never being one to enjoy success knowing there’s always a price to pay, I remained cautiously confident just sitting there.

Then it happened. I could feel the A-Fib trying to start up again, but I was hoping the Fire Wall would hold it back. But no. On feeling my pulse I knew I was in A-Fib again. There can’t be many greater depths of despair than a failed ablation for A-Fib and a possible future of no future. I already knew many ablations can start unraveling after about three months and required further ‘touch up,’ but 12 hours?

The only good thing was the H/R was bouncing around between 75 to 90 BPM. With my apparently mechanically sound heart I could tolerate this slower speed A-Fib, although my quality of life would still be drastically reduced. An hour later the doctor came in with a smile on his face. “The procedure went well. How are you feeling?” he asked. “Not too bad, but I’m still in A-Fib.” He couldn’t believe it, but on checking he confirmed the A-Fib. I said “You did the spot welding bit at the Fire Wall, yes?”. He answered, “Yes, it was all OK.”

“Did you get the guys with the black hats that were causing the problem in the first place?”

“We couldn’t find them, and we paced your heart up to over 171 BPM for as long as we could, and not a spark in there.”
What he probably didn’t know, but I do from experience, is that after an A-Fib attack your body seems to know it will destroy itself if it goes into A-Fib again too soon. So, you enter a period where you are somehow protected against any more A-Fib for whatever is your AF schedule at that moment in time. My schedule had dropped steadily from once every two weeks last August to every twelve hours before I’d go into an A-Fib 48 hour nightmare.

The doctor told me not to give up hope, because he had done a good job. And it takes three months before the ablation procedure can be classified a success or a failure. They decided to monitor me for a further 24 hours rather than discharge me. 24 hours later there was no change. So I asked if they could hit me with the two electric irons (Electrocardioversion) and get me back into NSR, so that I might enjoy the next 4 days in Delhi. For some reason in our many discussions the doctor had gotten the impression that I did not want to be shocked. But then he said, “OK, let’s go.”

One hour later I recovered from the Electrocardioversion to find I was still in A-Fib. Talk about being pi**ed off.

I spent the next 24 hours trying to come to terms with all this. There are other hospitals that do the same ablation treatment with perhaps higher success rates, but the top ones are in Cleveland, Ohio USA, Bordeaux in France, and Milan in Italy. And they all have long waiting lists and are expensive. Even in England which is a relative novice in the procedure, it costs at least $20,000. And they are on a steep learning curve compared to the top 3.

The only nearly 100% cure is via major open heart surgery, which is obviously the last resort, costs a bundle, and has long waiting lists.

RELEASED FROM THE HOSPITAL

I went to a 3 star hotel that night at about ten bells to wait out the next three days before my flight home.

Feeling pretty down on waking the next day, I could feel the pulse at my heart against the pillow. I heard 6 clear bumps before I pulled away as I decided to try to accept this A-Fib thing, and stop checking my pulse whenever an episode was kicking off. A similar thing happened later in the afternoon as I lay watching CNN, but not hearing a word.

To lift my head higher so that I could see the TV I had put my right hand under the pillow and subconsciously must have started counting my heart beats. I realized I had got to 13 solid beats before I felt the rhythm go wrong. 13 solid beats wouldn’t seem like a big deal, but to me they gave me a bit of relief. I was definitely feeling a bit better each day and more focused mentally.

I traveled everywhere around Delhi in a Tut Tut the next day, no walking. I decided I was possibly strong enough to make the 4 hour car journey to see the Taj Mahal, but just before the evening meal I felt strange things going on inside which resembled A-Fib trying to start. I struggled through the next 6 or 7 hours trying to keep my mind off the possible A-Fib which at least I knew was much weaker than before the ablation. Unlike before, I had no profuse sweating and continuous trips to the bathroom, followed by having to drink a lot of water.

I awoke the next morning sleeping on my left side, something I had stopped doing at least 6 months ago because of the A-Fib. Too tired to carry out my promise to not count heart beats any more, I could hear a steady bump, bump until I stopped counting. This was a good sign. That’s were I am now as I sit at the computer not knowing whether I am in A-Fib or not.

What I forgot to mention is that starting on the 18th of June I started taking the dreaded Amiodarone which burns out your thyroid gland over time. But the doctor asked me to take the tablets for the next two months to give my heart a break, and to possibly help it remodel itself for the good. Hopefully my heart would start getting in the habit of not being in A-Fib.

I’m feeling a bit stronger each day, but not taking it for granted. I’m taking two weeks off, although I can function like anybody else as long as I take my time.

Update: writing a month later Barry adds:

I am off of Amiodarone now and just take a small dosage of warfarin which I hope to stop taking in approximately one month’s time. I have been A-Fib free for at least a month now with no palpitations or “rumblings” since I stopped the Amiodarone. I feel normal again and can have a few beers in peace.

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